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Research Article ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2019.15.002667 Assessment of Dentists’ Knowledge Concerning the Management of Pregnant Women in the Dental Office Ilea A1, Lazăr AC1, Morar AE2, Boșca AB*3, Băbțan AM1, Petrescu NB1, Uriciuc WA1, Feurdean CN1, Câmpian RS1 and Șovrea A3 1Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania 2Postgraduate student of Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania 3Department of Histology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania *Corresponding author: Lecturer Bianca Adina Boșca, Department of Histology, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine Cluj-Napoca, Str. L. Pasteur, No. 4, Cluj-Napoca, Romania ARTICLE INFO abstract Received: Introduction: Published: February 11, 2019 Pregnancy is a physiological condition characterized by multiple chang- February 26, 2019 es in the entire woman’s body, including the oral cavity. Gingival hyperplasia, gingivitis, py- Citation: ogenicPurpose: granulomas and some salivary changes are common conditions in pregnant women. Ilea A, Lazăr AC, Morar AE, To assess the dental practitioner’s medical knowledge regarding the dental maneuvers allowed during pregnancy and the drug prescriptions for these patients in the Boșca AB, Băbțan AM, et al. Assess- Methodology: ment of Dentists’ Knowledge Con- dental office. cerning the Management of Pregnant In the present study, 128 active dentists with professional experience Women in the Dental Office. Biomed of one to 30 years were included. An online questionnaire was applied using the www. J Sci & Tech Res 15(2)-2019. BJSTR. isondaje.ro platform. The questionnaire was intended to be anonymous, with responses Keywords: MS.ID.002667. being collected online. The first set of questions assessed the socio-demographic data, the Pregnancy; Dental Treat- specialization, and the professional experience. The second set of questions referred to the ment; Dentistry; Dental Procedures; therapeutic approach of the pregnant women: the type of treatment and the period during Medical Education pregnancy when they chose to perform the dental treatments. The third set of questions re- ferred to the dental X-rays recommendation in pregnant women. The last category of ques- tionsResults: addressed to the medication prescribed or administered to pregnant patients. The data were quantified by calculating the arithmetic averages. Most partic- ipants had experience in the medical dental practice, therefore the answers were relevant for this study. More than half of the doctors surveyed stated that they would only treat a pregnant woman in emergency situations. Less than half would treat a pulp pathology only in emergency, but a pulp gangrene at any time during pregnancy. Regarding the extractions, the majorityConclusion: of the dentists would prefer to delay the treatment. An important number of dentists have insufficient knowledge related to the dental treatments that can be performed in a pregnant woman. Therefore, post-gradu- ate courses are required in order to up-date the knowledge of dentists. Introduction Systemic Physiological Adaptations in the Body During Pregnancy Pregnancy is a physiological condition characterized by multi- ple changes in the entire the woman’s body, including the oral cav- ity. Maintaining the dental and oral health during pregnancy is cru- The systemic changes that occur in pregnancy encompass var- cial, since there are specific limitations in the treatment of several ious anatomical and physiological adaptations in order to nurture oral diseases. Copyright@ 11188 Lecturer Bianca Adina Boșca| Biomed J Sci & Tech Res| BJSTR. MS.ID.002667. Volume 15- Issue 2 DOI: 10.26717/BJSTR.2019.15.002667 and to accommodate the developing fetus. These changes begin af- first trimester, especially during the first 13 weeks of gestation. ter the conception and affect every system in the body such as: According to the potential adverse effects and the risk to the fetus (1,6,7), US Food and Drug Administration (FDA) classified drugs a. Increased number of blood cells and plasma volume into five categories: b. Increased level of coagulation factors A. A - Human studies showed no risk to the fetus, c. Increased fibrynolitic activity B. B - Animal studies reported no fetal risk; there are d. Iron deficiency and anemia no studies in pregnant women; E.g: Amoxicillin, Cephalexin, e. Tachycardia Chlorhexidine, Clindamycin, Erythromycin, Metronidazole, Penicillin, Acetaminophen, Ibuprophen, Lidocaine, Prilocaine, f. Increased cardiac output Pilocarpine, Prednisolone, g. Increased heart rate C. C - Animal studies reported a risk to the fetus; no studies h. Movement of the diafragm to the top have been performed on pregnant women; E.g: Ciprofloxacin, Clarithromycin, Codeine with acetaminophen, Hydrocodone with i. Increased risk of apneea and dyspneea acetaminophen, Bupivacaine, Epinephrine, Mepivacaine; j. Hyperventilation D. D - These drugs should only be used in exceptional cases; k. Nausea and vomiting E.g: Gentamicin, Doxycycline, Tetracycline; l. Stomach acid burns E. X - Risks of using these drugs in pregnant women are muchAnalgesics: higher than benefits [5-7]. m. Behavioral changes The most common analgesic used during pregnancy n. Increased nutritional needs [1]. Decompensation of Different Organs is acetaminophen (Paracetamol). This is the safest, being included in category B by the FDA. The most commonly reported side effect of paracetamol is hepatotoxicity [1,8]. Other analgesics, such as During pregnancy, the normal function of various organs can ibuprophen, are also included in category B, but only in the first be impaired, resulting in pathological manifestations that could and second trimesters. In the third trimester, it falls into category interfereGestational with the oralDiabetes therapeutic Mellitus interventions. (GDM): D because it decreases the amount of amniotic fluid, and also limits Is defined as the vaginalAntibiotics: dilation during labor [1,9]. hyperglycemia that occurs for the first time during pregnancy. This Most of the antibiotics recommended by the may include cases of type 2 diabetes that have not been previously dentists are classified in category B, except for gentamicin, diagnosed but became symptomatic in early pregnancy, and true doxycyclineGentamicin and tetracycline,has been Reportedwhich are includedto Cause in Fetalcategory Toxicity: GDM which occurs later. GDM affects between 2 and 5% of pregnant women. Untreated, GDM could induce, besides the general complications, oral diseases, such as gingivitis and periodontal Whereas doxycycline and tetracycline cause dental dyschromia and diseaseArterial [2]. Hypertension: have a detrimental effect on bone development. Ciprofloxacin, a Actinobacillus broad-spectrum antibiotic, is commonly prescribed in periodontal is one of the most common diseases associated with infection. Recent evidence medical disorders in pregnancy and could lead to maternal fetal suggest that Ciprofloxacin is involved in arthropathy and has severe complications. The dentist should collaborate with the cardiologist effects on cartilage developing, therefore it is not recommended or the gynecologist before performing any dental treatment if the for pregnant women [10]. Metronidazole, included in group B, is pregnant woman suffers from hypertension, especially severe banned in the first trimester because it has teratogenic effects [11]. hypertension,Conditions and Requiring is under anti-hypertensive Anticoagulant Therapy:medication [2,3]. Oral Manifestations During Pregnancy If heparin is administered to the pregnant patient and a bleeding oral Oral manifestations during pregnancy include gingival intervention is necessary, the dentist should ask the physician hyperplasia, gingivitis, pyogenic granulomas and some salivary to adjust the dose of anticoagulant in order to ensure an INR changes. Oral health should be closely assessed and monitored both Drug(International Administration Normalised to Ratio) the Pregnant value lower Women than 2.2. [2,4]. before and during pregnancy. However, if the exacerbation of an oral disease occurs during pregnancy, the dentist should be aware that dental treatments are not completely contraindicated. The Since most medicines have side effects, these should be most appropriate time to perform dental treatments is the second avoided during pregnancy and administered only in serious trimester of pregnancy. The dental treatments in the first trimester conditions. Thus, the use of medication is not recommended in the of pregnancy is influenced by manifestations such as: accentuated Copyright@ 11189 Lecturer Bianca Adina Boșca| Biomed J Sci & Tech Res| BJSTR. MS.ID.002667. Volume 15- Issue 2 DOI: 10.26717/BJSTR.2019.15.002667 vomiting reflex, drowsiness and fatigue. In the third trimester, only be performed only using appropriate protection. In the 9th month emergencyGingivitis: and short interventions are recommended [2,5,12]. of gestation, the risk for fetus is much reduced [5]. The National Commission for Radiation Protection argues that fetal exposure Gingivitis is an acute and superficial inflammation at 50 mSv will not cause congenital defects, and if a radiological of the marginal gingiva and interdental papilla, that occurs mostly examination is essential for establishing the diagnosis,